Coordinated dental management in a patient with von Willebrand Disease

Celak, Dominic, Takako Tanaka, and Rose Geist

Background

von Willebrand Disease (VWD) is one of the most frequent hereditary bleeding disorders. Severity of bleeding and therapy are depends on its subtypes (Deficiency of qualitative, quantitative von Willebrand Factor(VWF), or its combination) However, decreased Factor VIII can be also seen in some types since unbound FVIII to VWF is destroyed in the circulation. Its diagnosis and treatment is complicated. Recently, the National Heart, Lung, and Blood Institute of the National Institute of Health issued the guideline for the diagnosis, evaluation and management of VWD.

Oral bleeding related dental treatment is a serious concern for both health care professions and patients with VWD as well as in other bleeding disorders. It is important for dental care providers to recognize the complex of the disease and communicate well with medical providers.

Case summary

A 60-year-old male patient with VWD was referred to our dental school clinic from Hemophilia treatment center (HTC) at Henry Ford Hospital in Detroit, Michigan.

He complained of “ongoing infection” for many years and wanted to have comprehensive dental care. The patient VWD was Type 2N VWD which is combination of reduced FVIII activity and VWF antigen, and abnormal VWF –FVIII binding. As well as Type3, VWF-containing concentrate were the primary therapy for this patient. He reported several dentists hesitated to treat him in the past and has been avoiding dental care due to his “bad experiences”.

Oral examination revealed the needs of multiple restorative and surgical dental works. Several teeth extraction was performed under coordination with HTC at HF and hemostasis was achieved without any events. The patient continues to have comprehensive dental care safely and satisfactory.

Conclusion:

This case illustrates the importance of interprofessional coordination in the oral health care management in bleeding disorders. Medical-decal team work can provide significant improvement of the patient’s quality of life.